Community nursing is a specialty. It requires the ability to provide care from a myriad of viewpoints.

This fast paced environment requires nurses be able to provide care for patients while at the same time supporting the providers clinical assistants, schedulers, and each other.

Community nursing is where the concept of holistic nursing is put into practice. From patient to patient throughout the day, nurses are constantly taking on additional roles, often serving as social workers, health counselors, case workers, and pharmacists, while at the same time providing traditional care.

In no place is patient advocacy seen more than in community health where on a daily basis nurses are providing outreach to both patients and their families, all the while balancing the social complexities required to provide culturally competent care in a multitude of languages.

These are the special skills that nurses at Martha Eliot Health Center, Children's' Hospital Boston possess.

The typical day at MEHC begins with the follow-up of laboratory work. At the same time, clinics are opened and nurses are responsible for direct patient care.

This care includes, but is not limited to: immunization and medication administration, dressing changes, suture removal, prenatal visits, colonoscopy preparations, diabetes teaching, blood pressure checks, family planning, and triage of all patients when appointments are unavailable.

In addition, protocols are applied to care for patients with positive pap smears, recent emergency room admissions, abnormal mammograms, and positive pregnancy tests.

When patient flow ceases, nurses work on medical forms and prior authorizations for medications, arrange for equipment and formulas, and follow up on complex patients.

Each task, however, is completed within the context of each patient's needs and the needs of the greater community.

Visits revolve around conversation and education; nurses often have to hear the unspoken and search for solutions to issues that are not often considered important in many cultures. They must recognize that obesity is a result of poor nutrition due to a lack of access to healthy foods and that asthma is caused by unhealthy environments such as the inadequate housing in which many families are forced to live.

Community nurses focus not only on immediate relief of the symptoms but search for solutions to the larger problems while speaking English, Spanish, Haitian Creole, and respecting a wide range of customs, cultural beliefs, and traditions.

Each day at MEHC is wrought with challenges, many which will not be solved by the close of business that day; regardless of this, the nursing team at MEHC is dedicated to the patients and their families.

The individual job satisfaction far exceeds the everyday challenges and it is this spirit and energy, collaboration and commitment that makes the health center team - nurses, doctors, administrators, and support staff - stand out in the community.

They are focused on the commitment to family centered care, respect, and compassion.

By Izabela Gasior, MS, BSN, RN, Rossana Encalada, BS, RN, Rose Mintor, BSN, RN, Manna Heshe, BSN, RN, Robin Crowley, BSN, RN, Ramonita Pedrogo, BSN, RN, Maria Martins, BSN, RN, and Jager Agraz, BSN, RN, all of the Martha Eliot Health Center, Children's' Hospital Boston.

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